Abstract
In his seminal text ‘The Gift Relationship’, Richard Titmuss famously contrasted voluntary and commercial systems of blood donation.(1) His conclusion that an altruistic system was superior immediately drew criticism from famed economist Kenneth Arrow, who argued that a commercial system provided more choice since hospitals and patients can choose from both commercial and voluntary sources, noting flaws in Titmuss’ epistemology and methodology.(2) Even philosopher Peter Singer, in a defence of Titmuss, acknowledged the role of a pricing system in alleviating an acute shortage of blood in Korea.(3) Medical services are more complex than blood donation. Hence, determining a fair price is a practice that has been fraught with controversy. India fined the drug company Novartis for allegedly overcharging for its painkiller Voveran.(4) Singapore’s medical statutory board fined and suspended surgeon Susan Lim for overcharging the Bruneian royalty.(5) The case was highly controversial as the Singapore Medical Council determined that there was an unstated ‘ethical limit’ to the prices of medical services(6), to the chagrin of some who viewed this limit as amorphous and arbitrary. This paper seeks to explore the pros and cons of the free market in regulating healthcare pricing and discuss whether there can be a fair and ethical price for medicine.
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